Contagion Nation

We can all be glad that swine flu is looking likely to top out at quite contagious rather than quite contagious and incredibly lethal. That's some good luck, in no small part because America isn't terribly well equipped to deal with contagious infections. In Contagion Nation, the Center for Economic and Policy Research lays out one of the reasons: Unlike most every developed country, America doesn't guarantee its workers paid sick days. As such, workers who think they might be getting sick frequently come to work anyway. They can't afford to forgo the day's paycheck. And then they get everyone else sick, too.

As CEPR points out, America is really alone in this boldly pro-contagion policy choice. "The U.S. is the only country among 22 countries ranked highly in terms of economic and human development that does not guarantee that workers receive paid sick days or paid sick leave," write the authors. "Under current U.S. labor law, employers are not required to provide short-term paid sick days or longer-term paid sick leave." This following graph tells the story well. Click for a larger version.

You're seeing two things here. The light blue line measures paid sick days. This is what you use if you need to take three days off because you have a fever. The dark blue line is paid sick leave. This is what you use if you need to take three months off because you have cancer. Every other country on the list offers at least one. Most offer both. The United States is alone in guaranteeing neither.

I'm working at a serious newspaper now and so I'm going to try to avoid words like "barbaric" to describe policy decisions I don't like. But this is certainly unnecessary. CEPR ends with the economic argument: "Each year millions of American workers go to work sick, lowering their own productivity and that of their coworkers and potentially spreading illness to their coworkers and customers." I'm willing to cut employers some slack: Many don't offer paid sick days because they don't think doing so will make them money. That is to say, they make marginally more money by letting their workers fall ill. That may be a good decision for the employer. But it's not good for the worker. And it's an appalling state of affairs. Residents of the world's richest nation should be able to stay home when they have the flu.

When you do things such as you are suggestion, wages decrease. They have to. I'm not saying that it wouldn't be good from a health policy perspective, or a humanity perspective, or anything, it's just that we seem to do things in this country and then say: wow, I didn't see *that* coming - when if anyone spent 1/2 a second doing the evaluation - well, it would have been obvious (well, congress HAS seen the evaluations re: cap and trade that is being put forth this week, they just seem to be ignoring it).

Mr. Klein,
Thanks for the post and I agree that this is a pitiful statement. There should be a mandated floor. As a small business owner I understand the cost burdens associated with paid leave but my employees are also my best assets. Yet competition is keen and margins are slim and, unfortunately, these "discretionary" expenses are often cut or avoided altogether.
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Much like the recent Obama pronouncement of a higher single, nationwide CAFE standard, I believe that a govt-mandated paid sick leave floor would establish a level-playing field and eliminate my concerns about my less-compassionate competitor having a new advantage.
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Question: Would the establishment of a floor also cause existing employers with a higher, voluntary total of paid leave days to cut back to the common standard? Unintended consequence?
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Also, what is the U.S.'s real average number of days provided voluntarily? Plugging that number in to the graph will give a more accurate picture of any gap that may exist between our country and others.

Jim, you're going to have to allow me to make some jokes at the expense of my new job. I'd think the fact that I could write that would actually be comforting to you. "Barbaric," after all, is in the post.

The UK entry is slightly misleading: the 10 days of sick leave at full pay is usually followed by Statutory Sick Pay, which is a weekly payment of around £80 (not much, but decent in the context of free healthcare) that can last up to 28 weeks. That's to say, if you are away from work for three months because of cancer treatment, you will receive benefits, have access to healthcare and won't get fired.

In the US, of course, the risk of losing one's job is compounded by the lack of access to healthcare at the low end. Oh, I suppose there's urgent care or the E.R., but even the former is going to set you back a week's wages.

That said, I had meant to write "newspaper" there, obviously not to imply that the American Prospect, who just published my piece on whether health care reform is an economic issue or a health issue, is not "serious." Changed.

Thanks, Ezra, for the post on the "Contagion Nation" report we released yesterday. I just wanted to respond here to a few issues raised in earlier comments.

pseudonymousinnc writes that the "UK entry is slightly misleading" because it doesn't count up to 28 weeks of Statutory Sick Pay. The graph in the post refers not to days of sickness-related leave, but to the "full-time equivalent" paid sick days or leave. So, for the UK, to see how much of a 50-day absence from work would be covered, we've taken the flat rate of about 75 pounds per week (minus a 3-day waiting period) and expressed it as a percentage of the median worker's wage over that period. That is how the UK ends up with just 10 full-time equivalent paid sick days. (For a lower-wage worker, this flat-rate benefit turns out to be a bit more generous. Full details are in the report.)

greentraveler writes that it would have been more appropriate to plug in the number of paid sick days that the employers provide voluntarily (or, say, by union contract). We do report some relevant numbers on employer-provided paid sick days in the report, but there are two problems here. First, the kinds of numbers greentraveler (and we) would like don't exist. The government keeps data on whether or not employers offer paid sick days and leave (about 60 million workers don't have it in any form), but does not collect data on how much employers give when they do offer it. Second, we'd also have to do the same thing for all of the other countries, where employers by social norm and union contracts typically provide more than the statutory minimum. The gap betwen the US and the rest of the world would not likely change very much.

2. it would be good if we could somehow see what is actually provided in this country...since we don't have a law (which would undoubtedly set a floor and a ceiling) then it would be good to see actual. My guess is we would look OK on sick days but would suck on sick leave

Just wanted to second greentraveler a bit. Offering paid sick leave has a positive externality: it's not only my own employees who are less likely to get ill, it's other firms' employees who come into contact with mine who are also less likely to get sick. So, its a prisoner's dilemma writ large: ensure general cooperation (paid sick days) by state mandate, and poof - paid sick days start paying for themselves. No mandate, and each individual employer has no incentive to unilaterally maintain paid sick days - meanwhile, competition rewards those who defect, resulting in a lousy equilibrium like our current one.

Curious: do you count 'Paid Time Off' when you are counting sick days, or not? That is, at my job I get fifteen days paid time off per year. Sick, or vacation. It's just one lump. Now obviously, everyone wants to use his or her time for actual *vacation* and not being sick, so we all come in sick all the time.

How do days like this count in these calculations, I wonder. I have found it to be (anecdata!) more and more common over the past five to ten years.